Managed-care firm Coventry threatens to terminate contracts of Baptist Healthcare and big Ashland hospital

Lexington Herald-Leader photo by Charles Bertram
Issues with the state’s managed-care companies continue to mount. Now Coventry Cares has told Baptist Healthcare System, which has hospitals in Lexington, Louisville, La Grange, Paducah and Corbin, that it wants to renegotiate its contract. 
The move comes just a week after Coventry and Appalachian Regional Healthcare came to a temporary agreement after Coventry threatened to terminate its contract and ARH sued Coventry. The managed-care firm has also told King’s Daughters Medical Center in Ashland it will terminate its contract after May 26.
Kentucky moved its Medicaid population to managed care Nov. 1, a move that is expected to save the state a lot of money. The three managed-care organizations that coordinate care for Medicaid recipients outside the Louisville area are paid on a per-month, per-patient basis, regardless of what care is needed. Coventry alleges “that it has too many high-risk patients and that the state needs to adjust the risk model so Coventry can receive more money for sicker patients,” report Beth Musgrave and Valarie Honeycutt-Spears for the Lexington Herald-Leader.
Unlike the state’s other two managed-care companies, Kentucky Spirit and Well Care, Coventry “opted not to charge patients a co-pay for pharmacy services. That business decision meant it got more people into the system who likely had more complicated health problems,” Musgrave and Honeycutt-Spears report. House Speaker Greg Stumbo has questioned the move not to charge a co-pay and wondered if it was akin to Medicaid fraud. (Read more)
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